Child traumatic stress can sometimes be mistaken for ADHD because of the overlap between ADHD symptoms and the effects of experiencing trauma. ADHD and child traumatic stress can also co-occur, creating a particularly complex picture. In this Guide, we define child traumatic stress and ADHD, explain how symptoms can overlap, and summarize some of the differences between the two. Understanding these differences can help parents and providers assess and treat children appropriately and more effectively.

Trauma Systems Therapy for Refugees Fact Sheets

Many refugee youth and their families experience war and violence prior to resettlement and continue to face ongoing acculturative and resettlement stress. Some have problems related to trauma and stress; however, cultural and practical barriers have led to very few of them receiving appropriate care. TST-R diminishes these barriers to care through implementing an adaptation of Trauma Systems Therapy (TST). Using an empirically-supported model of treatment, TST-R consists of three components of prevention and intervention: (1) parent outreach, focused on anti-stigma and psycho-education; (2) skills-based groups for youth; and (3) direct intervention for youth. For more information on this intervention, visit the general and cultural versions.

New Child Sexual Abuse Web Pages

Updated and new information on child sexual abuse is now available on the new Child Sexual Abuse pages on

Public Awareness

Bullying Prevention Awareness Month

In support of Bullying Prevention Awareness Month, the NCTSN has posted resources for families, teens, educators, clinicians, mental health professionals, and law enforcement personnel on how to recognize, deal with, and prevent bullying. Bullying can be verbal, physical, or via the Internet. It can severely affect the victim's self-image, social interactions, and school performance―often leading to insecurity, lack of self-esteem, and depression in adulthood. School dropout rates and absences among victims of bullying are much higher than among other students.

Domestic Violence Awareness Month

In recognition of Domestic Violence Awareness Month, the NCTSN is offering resources to help educate parents and families, educators, professionals, and policy makers about domestic violence. In an interview on PBS, Esta Soler from Futures Without Violence reminds us that “in the 20 years since the passage of the Violence Against Women Act, we have seen a 64 percent reduction for domestic violence among adult women. But we’re only really halfway there.” In addition, millions of children are exposed to domestic violence every year. Domestic violence incidents affect every person within a home and can have long-lasting negative effects on children's emotional well-being and social and academic functioning.



New Learning Center Course:
Working with Parents Involved in the Child Welfare System

Unresolved trauma can negatively affect parents’ coping, parenting, and the ability to interact effectively with the child welfare system. This online course was developed by the Birth Parent Subcommittee of the NCTSN Child Welfare Committee for individuals who work with birth parents involved in the child welfare system. The course focuses on child welfare activities such as investigation and removal, case management, visitation, family conferencing, court hearings, reunification, and termination of parental rights. The first module in the course provides a general introduction to the topic of birth parent trauma—how traumatic exposure can affect thoughts, feeling, and behaviors—and how these play out in day-to-day interactions. Subsequent modules will focus more specifically on the above-mentioned child welfare activities and provide information and strategies that will help child welfare personnel work more effectively with birth parents.

National Forum to Address Youth Exposure to Community Violence

Community violence—especially in urban areas—is an escalating crisis for far too many children and families across the United States. Given the urgency of this public health issue, the National Child Traumatic Stress Network is hosting a national forum to address community violence in the lives of youth and offer examples of solutions through partnership and collaboration from various sections of the country. Presenters will include individuals currently involved in addressing community violence: youth, mentors, therapists, police officers, and federal agency administrators.


Liza Suarez and Shannon Simmons are co-authors of Substance Abuse and Trauma, published in Child and Adolescent Psychiatric Clinics of North America (Volume 25, Issue 4). Substance use disorders (SUDs) are highly comorbid with posttraumatic stress disorder (PTSD) and the relationship between the two is complex and bidirectional, with shared social risk factors and biological pathways. Youth with co-occurring PTSD and SUD often have more severe challenges than teens with either disorder alone, with treatment needs that may involve multiple community systems. Authors review two clinical cases to illustrate these treatment principles, discuss integrated treatment, and conclude that service programs and youth will benefit from non-fragmented and multidimensional approaches that provide flexibility and a range of resources and expertise.

Joy Osofsky, Howard Osofsky, Carl Weems, Tonya Hansel, and Lucy King, in their article Effects of Stress Related to the Gulf Oil Spill on Child and Adolescent Mental Health published in the Journal of Pediatric Psychology (Volume 41, Issue 1), examined the interactive effects of stress related to the Gulf oil spill on mental health of children and adolescents who were also affected by previous hurricanes. Authors evaluated 1577 youth aged 3-18 years pre- and post-oil spills for posttraumatic stress disorder (PTSD) symptoms, previous hurricane exposure, and amount of oil spill stress. This study provides initial evidence linking stress related to the Gulf oil spill to youth mental health symptoms and concludes that the effects of the oil spill on youth mental health were most evident among those with cumulative risk.






This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.